ADA Conference 2011: The Good, The Bad, and the Errr... News

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The annual ADA Scientific Sessions conference is always kind of a mind-blower. It brings together 13,000 scientists, physicians, and other health care professionals (and now, bloggers!) from around the world.

This year, there will be hundreds of symposia, 59 special lectures, nearly 378 abstracts presented, and also nearly 2,000 research postersunveiled. Whew!

Thankfully, the ADA helps out bloggers and the media with a summary called "Clues to the News." Here is our take on many of the items highlighted:

GOOD NEWS

* Longer Lives for People with Type 1

Researchers in Pittsburgh, PA, followed hundreds of T1 patients born between 1950 and 1980, and discovered that "life expectancy for those diagnosed between 1965 and 1980 was approximately 15 years longer than for those diagnosed between 1950 and 1964, whereas the life expectancy among the general population at that time grew by less than one year." Their conclusion: "While those with type 1 are still living approximately four years less than those without, the survival gap is clearly shrinking." Nice!!

* Vitamin D Really Does Help

Two separate new studies seem to confirm that: 1) taking vitamin D helps prevent type 2 diabetes, and 2) vitamin D deficiency leads to complications. A third study even showed that "higher levels of vitamin D predicted better beta cell function and better glucose control during a glucose tolerance test." It's actually pretty well-known that vitamin D helps with type 2 diabetes, but what about for young people with type 1? One of these studies found that T1's who were deficient in vitamin D were twice as likely to develop eye problems, "though it's unclear why." This is all good news, IMHO, because taking Vitamin D is certainly an easy fix. Hit the drugstore, Friends!

* CGM for Infants & Toddlers

In a first-of-its-kind trial, researchers from around the country studied the feasibility of CGM use in 23 children with type 1 diabetes under the age of 4. Ten of those little folks were using an insulin pump and 13 were using multiple daily injections (MDI). "Each participant was provided with a CGM device (FreeStyle Navigator® or Paradigm®). Safety and use was monitored over 6 months."

The results? Side effects such as skin reactions were minimal. The kids ran high (hyperglycemia) for more than half the day on average, while lows (hypoglycemia) were infrequent. CGM did not improve glycemic control (A1C levels) in this group, BUT the researchers conclude that "it can help to ease parents' concerns of hypoglycemia, and in the future may allow more confidence in treating hyperglycemia in infants and toddlers." Now, if the sensors just weren't so gi-normous for these little bodies, ay...?

* The Artificial Pancreas Advances

About eight different studies were presented illustrating advancements in the JDRF Artificial Pancreas Project.

One study out of Santa Barbara, CA, involving Dr. Howard Zissser and Dr. Lois Janovic evaluated an "advanced, customized controller that can make determinations about how much insulin is needed and when it should be delivered."

Another study out of Germany looked at the Paradigm Veo low-glucose suspend (LGS) feature: can it prevent hypoglycemia in children? The answer was 'Yuppers!' According to the German doctors, this study "provides evidence for reducing the risk for hypoglycemia with LGS without compromising the safety of (insulin infusion therapy." Amen.

More studies looked at various aspects of safety and utility of a closed-loop system, including one that "validated" something called the Yale Insulin Infusion Protocol — detailed dosing instructions for in-hospital diabetics. (Wierdly, you can look up this automated dosing decision-maker here; just plug in your current BG level, and it gives you suggestions!)

BAD NEWS

* Heart Risk Higher with Metformin, Sulfonylureas

Using data from an electronic health record database, researchers found that "older patients with type 2 diabetes who started treatment with sulfonylurea (SU) drugs were significantly more likely to experience cardiovascular disease (CVD) than those who started with metformin." Hmm, old drug = bad / new drug = good?

However, there's a caveat: "This study was observational and does not prove cause and effect. Other factors may have explained the difference. (Metformin cannot be prescribed in patients with worse kidney and heart function, for example.)" OK. Still, the researchers insist that this finding is important because sulfonylureas continue to be commonly prescribed among elderly T2 patients, "and CVD is the leading cause of death among people with type 2 diabetes." Ugh.

* TZDs Linked to Eye Disease

As if the above weren't enough, researchers in the UK found that people who take thiazolidinediones (TZDs, such as rosiglitazone and pioglitazone) are 3.6 times more likely to develop diabetic macular edema (DME, a thickening and swelling of the retina due to leaking of fluid from blood vessels, which can lead to vision loss) than people who have never taken these drugs. In the words of the Madagascar Penguins, "Well, this sucks."

* Working the Night Shift Linked to T2 Risk

This shouldn't be surprising, I guess. Working the night shift for a long period of time doesn't sound very healthful, does it? Researchers in Boston found that for women doing so mildly increases the risk developing type 2 diabetes, even when BMI was accounted for. "Previous studies have shown that working the night shift interrupts circadian rhythms and is associated with obesity, metabolic syndrome and glucose dysregulation (abnormalities in regulating blood glucose)," the authors point out.

* Sleep Apnea Bad for Your Eyes, Nerves

And when you have sleep problems, it's all bad news too. Obstructive Sleep Apnea, which is growing more common and associated with type 2 diabetes. Researchers in the UK conducted two studies and found two bits of bad news: 1) that sight-threatening retinopathy (eye disease) was more than twice as common in those with diabetes and sleep apnea, and 2) that nearly 60 percent of those with diabetes and sleep apnea also had peripheral neuropathy, compared to 27 percent of those without the sleep disorder. Now they are presumably working on what to do about it.

* Diabetics 2x As Likely to Lose Hearing

This is REALLY bad news. DO YOU HEAR? This one scares me.

In a "meta-analysis" of 11 different related studies, Japanese researchers found that age-related hearing loss is twice as common in people with diabetes. Further investigation is required as to why, but "some researchers feel that neuropathy or vascular disease may be the mechanism." Man, isn't the vision threat enough?

* For Women with T1, Heart Risk Starts Early

"Women with type 1 diabetes are at four times greater risk for cardiovascular disease (CVD) than those who don't have diabetes, and pre-menopausal women with diabetes do not seem to have the beneficial effects on heart disease risk factors that other pre-menopausal women do." This according to a Colorado-based study that found significant differences in CVD risks between girls with type 1 diabetes and those who did not have diabetes, as early as adolescence.

"By contrast, boys with type 1 had no greater CVD risk factors than boys who did not have diabetes, though researchers are still investigating why." It seems that girls' risk factors in that age group are elevated level of c-reactive protein (CRP - a marker of inflammation), and high cholesterol. What the heck? In teen girls? More evidence that the world is unfair.

Why is there always more bad news from these studies than anything else, anyway?!

ERRR...

* Discounted / Generic Drugs Are "A Mixed Blessing"

What, affordable medications can do damage? This one caught me off-guard. It's an economic conundrum called "The Wal-Mart Effect," and it goes like this:

"People who have diabetes take an average of nine medications each day. When they don't take them, they are less likely to control their blood glucose, blood pressure and cholesterol, which may increase the risk of developing complications, having to go to the emergency room or being hospitalized. When drug prices go up, adherence often goes down. Discounted generic drugs (as low as $4 for a one-month supply) offered at stores such as Wal-Mart and Kmart have made some diabetes medications more affordable. However, this study shows that discounters of generics have since sharply raised average overall medication prices because of hikes in brand name drugs, eroding the savings for consumers."

In other words, aggressive pricing for generic medications has reportedly driven up the cost of non-generic meds by 113%. Holy Cow! I guess retailers have to make up for their losses somewhere, ay? So we pay for it in the end. (Note: I left this out of the 'Bad News' category because I'd have to agree with these authors that generics are a "mixed blessing.")

* It's Total Calories, Stupid!

There are always a few presentations that make me chuckle, with their no-brainer quality. Like this one this year: key to successful weight loss is not about the exact gram-count of carbs or protein — or any other single food component — at all, but rather about how many TOTAL CALORIES you take in. Surprise! It never ceases to amaze me that people don't recognize the simple math equation of weight loss: Total calories going in vs. total number of calories being expended.

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Thanks for the rundown! Although I'm not surprised by any of this. I have to say the calories in and out model is being seriously challenged: http://www.rationalskepticism.org/general-debunking/calories-in-calories-out-t20256.htmlhttp://www.raisin-hell.com/2010/05/why-first-law-of-thermodynamics-has-no.htmlhttp://migraineur.wordpress.com/2007/11/11/calories-in-calories-out/http://www.bullz-eye.com/furci/2011/the_calorie_theory.htmI have to wonder...A decade ago I was more active than I am now, my thryroid function was higher and I ate the same number of calories that I eat now. Only now, I shun all processed foods which I used to eat plenty of and I weigh 35 pounds less. So personally, I'm not so sure I agree, especially with the term "stupid" being involved.

Amy|2011-06-27

Fun rundown. Thx 4 the report.

Marianne|2011-06-27

Thanks for the rundown, I have enjoyed reading the news. However, I too, have to take exception to the "It's Total Calories, Stupid!" segment. Over the past few months, I've gradually increased my exercise to a minimum of 1.5 hours per day (a half hour or more each of gym, swimming and walking) on five days of the week with at least a half hour on each of the other two days. Hand in hand with that, I've decreased my calorie intake to 1200 or fewer calories per day and I've been struggling to lose weight - and I mean really struggling. All of the reading I've done leads me to believe that I should be losing a pound every three to four days and that definitely hasn't been happening. It's enough to make a girl depressed - again! Especially when I read statements like 'It's Total Calories, Stupid!'.

[...] are other intriguing trials going on with JDRF funding, including one using both glucagon and insulin. It’s not a cure, [...]

AmyT|2011-06-27

Apologies for the "stupid" ref - probably unnecessary. I just think PORTION SIZE has so much to do with our weight problem here in the U.S. I don't feel there's enough formal recognition of the fact that what kids are being taught to see as "normal" size portions now are 2-4x the size of what they were in the past. Too. Much. Food.

AllisonB|2011-06-27

Marianne: I've also been losing weight by increasing exercise and cutting calories, but what you're doing is overboard. The combination of calorie restriction and exercise works, but only up to a point. If your total calorie intake a day is less than 1200, your body will eventually go into starvation mode. Your metabolism slows down and you will not lose weight. You can lose 1-2 lbs a week, but you don't need to calorie restrict that severely. I have been using the website MyFitnessPal.com with great success. I lost 10 lbs in 3 months, and the community is really solid. I hope you check it out! Good luck!

Marianne|2011-06-28

Thanks Allison. Yes, I agree, it is extreme but I got there via a path of a half hour exercise three times a week, then four times a week then five times a week then I added walking to my trips to the gym at an increasing frequency until I got to an hour most days of the week and that still wasn't working on a diet of about 1400-1500 calories. I finally added half an hour swimming to the mix and reduced my calorie intake until I'm now at my current regime. I've seen a couple of doctors and a dietician. The dietician suggested that I might have a Vitamin D deficiency so I'm investigating that at the moment. We've already checked out thyroid problems.The point I was trying to make was that 'fewer total calories (i.e. food) + more physical activity = weight loss' is not always the case.

Anne Findlay|2011-06-28

has there been any research on whether it is harder for people with t1 diabetes to lose weight? I would like to see a side-by-side study of pwd compared to p-without-d.one thing that definitely makes it difficult is that insulin needs change with weight loss so if you don't catch on right away, you end up eating back a lot of calories to treat hypos.

Bob Holman|2011-07-01

Gary Taubes wrote a very compelling and well researched book concerning food, calories and nutrition - Why We Get Fat. It's a must read for anyone struggling with Diabetes - he also wrote two long articles in the NY Times, one that summarizes the book and one on Sugar (more recent). Both articles are easily found in a Google search.

Karen Rose Tank|2011-07-17

I loved the whole article until I too got to the last one about weight loss. I am a type 1 who went back to school in nutrition to become a health and nutrition coach mainly for people with diabetes... both type 1 and type 2. Sensitivity to each person's individual situation and body is critical. Yes the amount and type of food eaten as well as portion size is important... BUT... getting there is a whole different story. As David Kessler writes in his book "The End of Overeating," humans have evolved to crave carbs highly caloric foods with carbs, fats, salt and sweetness... that kept us alive in times of famine. Well the sad joke is that we have been manipulated by food companies- like the Cinnabon- which sets off our cravings every where we turn in our "modern" society. Couple that with more sedentary life styles... and you have a recipe of weight gain.We all need support to change our ingrained and emotional eating habits. It is easy to chalk it up to portion size, but in fact basing your food choices of protein, lots of veggies, healthy fats and fiber, keeps everyone's blood sugar more stable and their tummies more satisfied... a necessary component for reducing and resisting those cravings. The more you reduce all those carbs in your diet... the easier it gets to reduce your cravings and reset your palate for fresh, whole foods.PLUS, thin people often have no tolerance for those of us who struggle with our weight. Either they did not grow up with the emotional noose of food, or their bodies just have better functioning of the brain-gut- hunger- satiety connection. You CAN re-establish this but it takes time and support and LOVE! That is what I now do for a career... those of us with diabetes certainly need that support and LOVE! This is no easy disease to live with!My website is www.RoseHealthCoaching.com if you want to know more about my approach.I also run cooking support groups in the central NJ area to empower those of us who struggle HOW to cook and love eating low carb, healthy whole foods. www.TheSuppersPrograms.org... check out our message and approach... and recipes.Karen Rose Tank, MS, Certified Health Coach, Type 1 for 15 years

Xander|2011-08-08

In relation to the calorie matter, there is some evidence to suggest that a calorie "in" to one person can be metabolically different than a calorie "in" to another, due to a difference in processing calories upon food ingestion. Here is my best interpretation:(A) The body generates heat in response to the ingestion of food.(B) This increases the metabolism.(C) The body utilizes some stored fat to fuel the increased metabolism.It has been proposed* that insulin resistance and/or deficiency decreases (A), which results in [my words: it being easier to gain weight and harder to lose weight for a person with insulin resistance]. So, you could have two people (consider age/sex/BMI/etc to be the same) who ingest equal amounts of calories and get the same level of physical activity yet experience different outcomes in terms of weight....because one is burning less calories than the other secondary to a physiological defect. There is more to "calories out" than physical activity. For individuals whose bodies are not addressing those other factors correctly, it will take more exercise compared to others in order to make up the difference so that they can achieve the same degree of weight loss.*Felig P: Insulin is the mediator of feecling-related thermogenesis: insulin resistance and/or deficiency results in a thermogenic defect which contributes to the pathogenesis of obesity. Clinical Physiology 4(4):267-273, August 1984(A reminder: While insulin resistance is commonly associated with type 2 diabetes, there will a subset of individuals with type 1 diabetes who have insulin resistance.)

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